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Saturday, April 09, 2011

A listening government - or a government in retreat?

Of all the changes introduced by the Coalition government since it took office last May, it is fair to say that its proposed reforms to the National Health Service have been the most politically controversial.

What about the cuts, I hear you say? Haven't they caused much more widespread public anger and made a much deeper impact on local communities?

Well, yes. But there was a broad political consensus dating back to well before the general election that spending cutbacks needed to be made – the only real disagreement being about the extent of them.

More importantly, the Coalition had a mandate for them. Labour lost the election primarily because, rightly or wrongly, the party was seen to be in denial about the size of the deficit and the remedial action needed to address it.

By contrast, the NHS reforms were not even spelled out in the Coalition Agreement, which infamously promised that there would be "no more top down reorganisation of the NHS."

Indeed, the agreement implicitly accepted that Primary Care Trusts would remain, promising a stronger voice for patients locally through directly elected individuals on the boards of their local PCT."

However when the legislation was published, it turned out that health secretary Andrew Lansley was proposing the abolition of PCTs and the transfer of their entire commissioning role to GPs.

Much of the anger felt by Liberal Democrats over the reforms can be traced back to this piece of perceived duplicity on Mr Lansley's part.

There is said to be anger in Number 10 at the way Mr Lansley has handled the reforms – but to my mind the fault lies more with Downing Street for not paying sufficient attention to their likely political impact.

As with the Forestry Commission sell-off debacle, No 10 seems to have been so focused on deficit reduction in the government's early days that it took its eye off the ball in other, seemingly less contentious areas.

Deputy Prime Minister Nick Clegg must bear some of the blame too, for not realising the strength of feeling in his own grassroots against the proposals.

It is only since his party's Spring conference delivered a huge thumbs-down to the reforms that Mr Clegg has started to argue for changes to the legislation.

So it was no great surprise that, this week, the government was forced to announce it was taking a raincheck on the implementation of the reforms while it conducted a further "listening exercise" with the public and health professionals.

It amounted to an admission that the reforms had been introduced without the necessary buy-in from either the public or, more importantly, those people who will be charged with making them work.

Should we see it as the prelude to a dramatic U-turn? Or is it simply a belated effort by Prime Minister and ex-PR man David Cameron to 'sell' the proposed changes?

Time will tell….but Mr Cameron's apparent openness to changes in the legislation suggests this is more than mere window-dressing.

The backbench health committee of MPs, for instance, wants to see the new fund-holding commissioning bodies drawn from a much wider membership, including councillors and hospital doctors.

Although this is more in tune with the spirit of what was in the original Coalition agreement, any weakening of the central proposal to hand power to GPs will be seen as a major political reverse for Mr Cameron.

The political commentator Benedict Brogan said of this week's events: "The underlying impression was one of an administration in retreat, forced to trim on policy because it got the politics wrong."

Mr Cameron is finding that the line between being a "listening government" and a "weak government" is sometimes a very fine one.

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"He saw politics very much like Trollope, as the interplay of personalities seeking preferment, rather than, like me, as a conflict of principles and programmes about social and economic change."

Denis Healey, writing about Roy Jenkins in "The Time of My Life."

"I'll tell you what happens with impossible promises. You start with a series of far-fetched resolutions, and these are then pickled into a rigid dogma, a code. And you go through the years sticking to that, outdated, misplaced, irrelevant to the real needs, and you end in the grotesque chaos of a Labour council, a Labour council, hiring taxis to scuttle round the city handing out redundancy notices to its own workers. I'll tell you - and you'll listen - you can't play politics with people's jobs and with people's homes and with people's services."

Neil Kinnock, Bournemouth 1985

"But the most eloquent message concerns the Blair government. It must be right at all times. Above all, the integrity of the leader can never be challenged. He never did hype up intelligence. He didn't take Britain to war on any other than the stated terms. Any suggestion of half-truth, or disguised intention, or concealed Bushite promises is the most disgraceful imaginable charge that deserves a state response that knows no limit.

"That's how a sideshow came to take over national life. Now it seems to have taken a wretched, guiltless man's life with it. Such is the dynamic that can be unleashed by a leader who believes his own reputation to be the core value his country must defend."

Hugo Young, on the death of Dr David Kelly, 2003

"The socialism I believe in is everyone working for each other, everyone having a share of the rewards. It's the way I see football, the way I see life."